Provider Demographics
NPI:1407974900
Name:HARPER, BRENDA MAY (LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MAY
Last Name:HARPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2342 N HYDE AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4148
Mailing Address - Country:US
Mailing Address - Phone:208-888-3110
Mailing Address - Fax:
Practice Address - Street 1:870 N LINDER RD
Practice Address - Street 2:SUITE C
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8500
Practice Address - Country:US
Practice Address - Phone:208-888-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLSCW-10561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical